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A 54-year-old man presented with a 2-day history of impaired concentration, dysgraphia, dysarthria and ataxia but with no focal sensory or motor deficit. Seven days before, he had received his first cycle of chemotherapy with capecitabine to treat adenocarcinoma of the gall bladder, identified at cholecystectomy. Since the start of the treatment he had felt tired and ‘spaced out’, and reported that he finally had driven his car into a wall when trying to park outside his house. He had a history of ulcerative colitis, hypercholesterolaemia and obstructive sleep apnoea. He was taking capecitabine (2800 mg two times per day), mesalazine, domperidone, fluoxetine and atorvastatin.
On examination, he had broken persuit eye movements, mild left upper motor neurone facial weakness, mild right hand weakness, incoordination of …
Contributors ZY and MSO contributed to the original write-up of the manuscript. ZY, RB and BS contributed to patient care and revision of the manuscript in their respective specialty. RB provided the high-quality images and the figure captions.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned. Externally peer reviewed by Jeremy Rees, London, UK.